On Rural Medical Care and Health Undertaking Development during New Medical Reform

Based on in-depth survey of township hospitals in Lushan County of Henan Province, this paper studies the development situations of rural medical care and health undertaking in the course of new medical reform. Results show that both rural medical institution and public health undertaking have considerable development in this course. Working capital situation gradually turns better. However, there are still problems and challenge of shortage of high quality medical care personnel, lack of employment mechanism, poor medical environment, and imperfect bidding and purchasing system of medicines. To further develop rural medical situation, it should improve medical environment, speed up informationization construction, and give prominence to functional orientation.

Health care reform in the USA: Recommendations from USA and non-USA radiologists

AIM: To compare the opinions and recommendations of imaging specialists from United States (USA) and non-USA developed nations for USA health care reform. METHODS: A survey was emailed out to 18 imaging specialists from 17 non-USA developed nation countries and 14 radiologists within the USA regarding health care reform. The questionnaire contained the following ques tions: what are the strengths of your health care system, what problems are present in your nation's health care system, and what recommendations do you have for health care reform in the USA. USA and non-USA radiologists received the same questionnaire. RESULTS: Strengths of the USA health care system include high quality care, autonomy, and access to timely care. Twelve of 14 (86%) USA radiologists identified medicolegal action as a major problem in their health care system and felt that medicolegal reform was a critical aspect of health care reform. None of the non-USA radiologists identified medicolegal aspects as a problem in their own country nor identified it as a subject for USA health care reform. Eleven of 14 (79%) USA radiologists and 16/18 (89%) non-USA radiologists identified universal health care coverage as an important recommendation for reform. CONCLUSION: Without full universal coverage, meaningful health care reform will likely require medicolegal reform as an early and important aspect of improved and efficient health care.

A Comparative Analysis of the Old Medical Structure and the ACO Vision 2030 in Saudi Arabia

This article explores the progress of the healthcare sector in the Kingdom of Saudi Arabia over the past two decades. Through continuous coordination and efforts to improve the quality and quantity of health services, the government has significantly increased the availability of health facilities across the nation. This steady growth has allowed the country to maintain an upward trajectory in healthcare sector development in comparison to other countries. The Saudi Arabian government is preparing to implement Accountable Care Organizations (ACOs) as part of their “Vision 2030.” By aligning with the goals of this visionary roadmap, the government aims to address the challenges faced by the existing healthcare system under the Ministry of Health (MOH). This strategic move is expected to transform the healthcare sector, positioning Saudi Arabia at par with its international counterparts and bolstering its economic competitiveness. This article highlights the historical context of Saudi Arabia’s healthcare system, and compares it with the forthcoming ACO implementation under “Vision 2030.” This information provides valuable insights into the trajectory of the country’s healthcare landscape and the potential impact of ACOs in shaping the Kingdom’s future in healthcare and economic development overall.

The Pathway of China’s Integrated Delivery System:Based on the Analysis of the Medical Consortium Policies

With the deepening of China’s health-care reform,an integrated delivery system has gradually emerged with the function of improving the efficiency of the health-care delivery system.For China’s integrated delivery system,a medical consortium plays an important role in integrating public hospitals and primary care facilities.The first medical consortium policy issued after the COVID-19 pandemic apparently placed hope on accelerating the implementation of a medical consortium and tiered health-care delivery system.This paper illustrates the possible future pathway of China’s medical consortium through retrospection of the 10-year process,changes of the series of policies,and characteristics of the policy issued in 2020.We considered that a fully integrated medical consortium would be a major phenomenon in China's medical industry,which would lead to the formation of a dualistic care pattern in China.

The innovations in China’s primary health care reform: Development and characteristics of the community health services in Hangzhou

Objective:This study focuses on Hangzhou,a Chinese city with a population of nine million urban and rural residents,to examine the successful development and innovation experience of its primary health care service system during the new health reform in China since 2009 and then dis-seminate the findings through international third parties.Methods:Measures such as data analysis,study of documents and regulations,fieldwork,and expert discussions were used to systematically investigate primary health care in Hangzhou.The findings will have a profound practical impact on the health reform for nine million rural and urban residents throughout Hangzhou’s municipal boroughs.Results:Community health services in Hangzhou are characterized as follows:They are gov-ernment led;they are guaranteed with enough financing,personnel,facilities,and regulation;sup-ported by the unified information platform;general practitioners have been assigned the key role of health‘gatekeepers’;they provide primary care combined with basic public health services;there are integrated urban and rural health services and insurance coverage;and there is health care-pen-sion-nursing integration and general practitioner-contracted‘smart’services.Preliminary data collection and analysis indicate that the basic health status of Hangzhou residents is superior to that of residents of China as a whole,and some health indicators in Hangzhou are comparable to those in Western developed countries.Conclusion:It is reasonable to believe that the primary health care level in China,including Hangzhou,will be further developed and promoted with indexed performance evaluations and more effective implementation of additional measures.

Finance Policy for Public Health Disease Prevention: Addressing the Number One Cause of Death in the Western World

Background: The lack of a finance policy to cover heart coronary artery disease CT imaging led to an epidemic of heart disease, the most common cause of death in the United States. The difficulty for many adults to pay $150 for CT heart imaging was the impetus for public health reform through legislative intervention. Methods: The key to finance policy reform was the organization of the medical environment involved in asymptomatic heart disease. Using the ecosystem paradigm for organizational alignment, the legislative goal was financing the $150 heart image to identify and medically prevent symptomatic heart disease, obviating future surgical costs of >$100,000. Results: Assisted by stakeholders for public health reform, a 3-year initiative to pass a legislative bill mandating health insurance coverage of $150 heart imaging was signed into law. Understanding the legislative process was necessary for successful advancement of public health and eliminating unnecessary costs of an established conservative ecosystem. Conclusions: Texas was the first state to achieve this legislative goal and New Mexico soon followed. If political environments, regardless of country following this road map of public health reform, a significant beneficial impact upon heart disease, its cost, and healthier public would result.

Professionalism and patient education in urologic surgery

Medical professionalism provides the guidelines that govern the patient-physician relationship. This implicit contract requires that patients be informed before making decisions regarding their medical care. Educating patients about diagnostic and treatment decisions is critical to an informed decision-making process. Shared decision-making is a recent paradigm shift in patient education that allows patients to make decisions based both on the counsel of their physicians and according to their own preferences and values. This approach moves away from previous models that focused on physicians or third-party payers as the arbiters of diagnostic and treatment choices. Urologic surgeons have been at the forefront of shared decision-making research and continue to promote this concept in the most recent American Urological Association Guideline on Detection of Prostate Cancer. Unfortunately, the feefor-service financial structure that predominates in the United States' health care system provides a disincentive for shared decision-making. By promoting patient volume rather than time spent with patients, this system rewards physicians who spend less time educating patients about diagnostic and treatment options. Therefore, to promote adherence to the educational responsibility inherent in medical professionalism, werecommend physician payment reform that rewards physicians for time spent with patients rather than the volume of patients seen.

健康中国背景下的“看病贵”与政府支出——基于资源配置结构性失衡视角的分析

“看病贵”意味着医疗卫生资源转化为医疗卫生服务的成本高,有限资源下医疗卫生服务供给的数量和质量难以满足公众健康需求,从而直接影响健康中国建设。同时,人口快速老龄化带来的医疗卫生需求爆发式增长,将形成医疗卫生体系的额外压力,加剧供求矛盾。基于医疗卫生资源配置结构性失衡视角研究“看病贵”与政府支出之间的关系发现:政府增加卫生支出会通过加剧人力资源配置的结构性失衡而加剧“看病贵”问题;只有将增加政府卫生支出与深化医疗卫生体制改革相结合,才能真正缓解全社会“看病贵”问题。因此,应深化公立医院改革,优化政府对医疗卫生资源的配置方式,加强基层医疗卫生体系建设,重塑医疗卫生服务治理模式,构建专业化治理模式,系统性重构中国医疗卫生领域人才建设。

综合医疗制度改革对中国家庭财务脆弱性的影响

健康风险作为背景风险的重要组成部分,会给一般家庭造成明显的财务脆弱性。医疗制度作为重要的社会保障基础,可以为家庭提供关键的健康保障,从而有效缓解家庭财务脆弱性。引入2010—2020年中国家庭追踪调查数据(CFPS),构建准自然实验研究体系,采用双重差分法检验了综合医改政策对家庭财务脆弱性的影响特征及其作用机制。研究发现,综合医改政策的实施显著缓解了家庭财务脆弱性,并且这一效应在城镇家庭、有老年人的家庭、儿童健康风险高的家庭、弱社会网络家庭、使用互联网的家庭以及社会信任度高的家庭中表现更加明显。同时,综合医改政策可以通过降低家庭医疗负担、提升家庭劳动参与、改变家庭风险态度等途径缓解家庭财务脆弱性。本文为评估综合医改政策及其对家庭财务影响的有效性提供了新视角,为进一步从微观层面深化医疗卫生体制改革提供了重要的政策启示。

北京市综合医改前后社区卫生服务机构治疗费用的受益人群分析

背景厘清社区卫生服务机构主要服务的人群特点,对下一步社区卫生服务机构的精准改革具有十分重要的意义。目的通过分析综合改革前后北京市社区卫生服务机构治疗费用的受益人群特征,为下一步改革政策制定和调整提供精准的数据支持。方法本研究基础数据来源于2016—2019年北京市卫生总费用核算基础数据库,其他数据来源于2016—2019年《北京市卫生健康统计年鉴》《北京市卫生财务统计年报》《北京市卫生费用核算报告》等。采用多阶段分层整群抽样的方案选取社区卫生服务机构,从HIS系统纳入全年的门诊数据、住院患者的数据。采用卫生费用核算体系2011(SHA2011)核算、分析社区卫生服务机构治疗费用的受益人群状况。结果2016—2019年北京市社区卫生服务机构治疗费用从121.81亿元增长至222.45亿元,年均增长19.07%。40岁以上中老年患者治疗费用历年占比均在92%以上,60~岁、80~岁两个年龄组患者治疗费用增长较快,年均增速分别为24.08%、25.84%;治疗费用中内分泌、营养和代谢疾病,症状、体征和检验异常、循环系统疾病占比最高,内分泌、营养和代谢疾病,神经系统疾病,症状、体征和检验异常疾病治疗费用增长较快,年均增速分别为40.11%、48.40%和32.43%。结论综合改革后分级诊疗成效初显,社区医疗服务资源主要由中老年患者、内分泌、循环系统等慢性非传染性疾病患者所消耗,改革引导更多中老年和慢性病患者流向社区,社区卫生服务机构应该从服务能力、人才队伍、慢性病管理、医联体建设等多方面着手,提升其服务能力,巩固和维持改革的效果。

北京市医药分开、医耗联动综合改革前后老年人群医疗机构治疗费用流向研究

目的通过研究北京市医药分开、医耗联动综合改革前后老年人群医疗机构治疗费用流向变化,为优化老年患者就诊流向提供数据参考。方法采用多阶段分层整群抽样方法获取样本,基于《卫生费用核算体系2011》核算老年人群的治疗费用。结果2016—2019年北京市老年人群医疗机构治疗费用由604.57亿元增长至797.54亿元,年均增速为6.83%,其中社区卫生服务中心治疗费用增长最快,增速达24.04%,治疗费用占比由11.31%增长至17.71%,三级医院治疗费用占比下降4.39个百分点。门诊患者治疗费用流向优化明显,低龄老年门诊患者更愿意在社区就诊,但高龄老年患者门诊流向优化更明显。内分泌、营养和代谢疾病,神经系统疾病等慢性病老年门诊患者治疗费用大幅度流向社区卫生服务中心。结论改革对不同年龄和疾病的老年患者就诊影响不同,建议加强基层医疗卫生机构服务能力建设,凸显二级医院发展特色,精准完善老年患者分级诊疗体系。

医保政策与健康伦理的冲突与对策分析

针对现行医保政策与患者健康伦理的冲突现象进行原因分析,汇总原因如下:医保基金的可持续发展状况堪忧、医保管理体系有待完善、医保管理部门与医疗机构协商谈判机制不健全、医疗卫生资源配置和人民群众的卫生服务需求不匹配。针对上述原因,应从调整医保基金筹资机制、构建多层次医疗保障体系、健全医保管理体系、建立医保管理部门与医疗机构协商谈判机制、促进医疗机构精细化管理程度等方面入手,维护医保基金安全,提高患者就医满意度。

医学教育中人文关怀精神培育面临的问题及分析

医学科学精神和人文关怀精神是培养医学人才的“双引擎”,而人文关怀精神的塑造与医学生的价值取向、价值目标正确与否密切相关。人文关怀精神的培育目前已经成为高等医学院校大学生素质教育工作中的一项重点内容。总体来说,医学人文关怀精神培育还存在弱化的现象,难以满足现代医学生培养的需要。健康中国战略也需要医学人文关怀精神。医学院校应该在加强和改进高校思想政治工作的利好局面下,转变教育观念,加强医学人文关怀教育,从人文关怀教育培养目标、课程设置、教学计划、教学内容、教学方法与手段等方面开展医学人文教育教学改革,构建医文相通的教师队伍,开展高质量的校园文化活动,营造医学人文氛围,从而为“健康中国”输送“医术高超、情操高尚”的医学人才。

“岗课赛证”融通下的高职智慧健康养老服务与管理专业人才培养模式研究与实践

当前,我国养老服务产业进入新蓝海,为高职养老服务类专业提供了广阔的发展空间,但与用人需求相对应的是,高职智慧健康养老服务与管理专业发展还存在供需不匹配、岗课不对接、留存不理想、认同不到位等问题,通过推进“岗课赛证”综合育人改革,进一步优化顶层设计、深化产教融合、强化以赛促学、推行以证代评、健全体制机制,可为养老服务产业培养和输送大批高素质复合型技术技能人才。

突发公共卫生事件下的检验技术本科教学改革思考

近年来,在对不确定且影响范围较大的突发公共卫生事件处置中,检验专业发挥了重要的作用,同时也对检验技师在生物安全规范、检测技术整合及参与临床诊断上提出更高的要求.如何培养拥有更全面的理论及实践能力的检验专业人才显得尤为重要.本文从新型冠状病毒感染疫情带给检验专业的挑战及机遇出发,立足本科教育,通过对本科学生在校理论课程设置与临床实习两方面的改革,以期构建顺应突发公共卫生事件要求的检验本科教学体系.

新医科背景下医防融合医学人才培养模式的研究

为顺应国家对医学教育创新发展的规划和布局,改革医学人才培养模式势在必行。现行医学人才培养体系存在课程体系不完善、医防融合理念不足、实践教育薄弱等问题。提出基于知识—能力—情感的医学人才培养模式,改革临床医学与公共卫生课程设置;加大公共卫生实践技能培养;创新医防融合师资队伍建设途径;推行思政与人文协同育人;实施灵活多样的教学方法等应对策略,为促进医学教育的改革和构建医防融合的人才培养模式提供依据。

医药卫生改革中的财务风险管理:挑战、机遇与对策

随着医药卫生改革的深入进行,财务风险管理在医疗机构运营中的重要性日益凸显。聚焦医药卫生改革背景下的财务风险管理,分析改革过程中医疗机构面临的财务风险挑战与机遇,并探讨相应的对策。通过对政策调整、市场变化以及内部管理等方面的综合分析,揭示财务风险管理的现状及存在的问题。采用文献研究和案例分析方法,提出了包括优化内部控制、加强预算管理、提高风险意识等在内的一系列应对策略。研究结果表明,通过科学合理的财务风险管理,可以有效应对改革中的挑战,把握发展机遇,为医疗机构的可持续发展提供保障。

在京部属高校医保制度的调查与思考

随着我国医疗保险覆盖面的逐步扩大,医保制度使居民享受到更高质量的医疗服务、医保实时结算等一系列实实在在的实惠以及更大的就医便利度,“全民医保”已然成为大趋势和共识。为探索在京部属高校医保制度改革前景,改变当前在京部属高校师生就医困难、选择受限、无法享受优质医疗资源,以及在京部属高校未被纳入医保系统、医患矛盾日益加重等困境,笔者调查相关高校实施医保政策制度经验,提出医疗改革可渐进式由公费医疗并入医保,或增加定点医疗机构的形式,以期早日为在京部属高校师生提供更便利、更优质的医疗服务。